Dokument

Zusammenfassung:
Regionalanästhesiekatheter haben sich im Laufe der Zeit als fester Bestandteil einer postoperativen Schmerztherapie etabliert. Jedoch ist jede Regionalanästhesie mit gewissen Risiken und Nebenwirkungen behaftet. Ein Hauptproblem ist die Katheterkolonisation mit Bakterien, die zu lokalen Symptomen und somit zu einer vorzeitigen Entfernung eines Regionalanästhesiekatheters führen können. Daher ist es das Ziel dieser Studie, herauszufinden, ob ein mit einem antimikrobiellen Wirkstoff wie Chlorhexidingluconat vorbehandeltes Pflaster die Rate der Katheterkolonisationen mit Bakterien signifikant zu senken und es so zu ermöglichen, die Regionalanästhesiekatheter zur postoperativen Schmerztherapie länger in situ zu belassen.

Bibliographie / References

1. Sievert D, Armola R, Halm MA. Chlorhexidine gluconate bathing: does it decrease hospital-acquired infections? Am. J. Crit. Care 2011;20(2):166–70.
2. Sessler DI. Long-term consequences of anesthetic management.
3. Ruppen W, Derry S, McQuay H, Moore RA. Incidence of epidural hematoma, infection, and neurologic injury in obstetric patients with epidural analgesia/anesthesia. Anesthesiology 2006;105(2):394–9.
4. Capdevila X, Pirat P, Bringuier S, Gaertner E, Singelyn F, Bernard N et al. Continuous peripheral nerve blocks in hospital wards after orthopedic surgery: a multicenter prospective analysis of the quality of postoperative analgesia and complications in 1,416 patients. Anesthesiology 2005;103(5):1035–45.
5. Effectiveness and safety of postoperative pain management: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data. Br J Anaesth 2008;101(6):832–40.
6. [16] Borgeat A, Tewes E, Biasca N, Gerber C. Patient-controlled interscalene analgesia with ropivacaine after major shoulder surgery: PCIA vs PCA. Br J Anaesth 1998;81(4):603–5.
7. Orlikowski C, Majedi PM, Keil AD. Bacterial contamination of epidural needles after multiple skin passes. Br J Anaesth 2002;89(6):922–4.
8. Macfarlane AJR, Prasad GA, Chan VWS, Brull R. Does regional anaesthesia improve outcome after total hip arthroplasty? A systematic review. Br J Anaesth 2009;103(3):335–45.
9. Raad I, Reitzel R, Jiang Y, Chemaly RF, Dvorak T, Hachem R. Anti-adherence activity and antimicrobial durability of anti-infective-coated catheters against multidrug-resistant bacteria. J. Antimicrob. Chemother. 2008;62(4):746–50.
10. Karpanen TJ, Casey AL, Conway BR, Lambert PA, Elliott TSJ. Antimicrobial activity of a chlorhexidine intravascular catheter site gel dressing. J. Antimicrob. Chemother. 2011;66(8):1777–84.
11. Changing epidemiology of central venous catheter-related bloodstream infections: increasing prevalence of Gram-negative pathogens. J. Antimicrob. Chemother. 2011;66(9):2119–25.
12. Singelyn FJ, Deyaert M, Joris D, Pendeville E, Gouverneur JM. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth. Analg. 1998;87(1):88– 92.
13. Singelyn FJ, Contreras V, Gouverneur JM. Epidural anesthesia complicating continuous 3-in-1 lumbar plexus blockade. Anesthesiology 1995;83(1):217–20.
14. Kindler CH, Seeberger MD. Infectious complications after epidural anesthesia.
15. Sato S, Sakuragi T, Dan K. Human skin flora as a potential source of epidural abscess. Anesthesiology 1996;85(6):1276–82.
16. Kinirons B, Mimoz O, Lafendi L, Naas T, Meunier J, Nordmann P. Chlorhexidine versus povidone iodine in preventing colonization of continuous epidural catheters in children: a randomized, controlled trial. Anesthesiology 2001;94(2):239–44.
17. McCabe SET, Christie IW. Epidural complications across the globe.
18. [13] Borgeat A, Blumenthal S, Lambert M, Theodorou P, Vienne P. The feasibility and complications of the continuous popliteal nerve block: a 1001-case survey.
19. Intravascular catheter-related infections in an Indian tertiary care hospital. J Infect Dev Ctries 2011;5(6):452–8.
20. O'Grady NP, Chertow DS. Managing bloodstream infections in patients who have short-term central venous catheters. Cleve Clin J Med 2011;78(1):10–7.
21. Scott DA, Beilby DS, McClymont C. Postoperative analgesia using epidural infusions of fentanyl with bupivacaine. A prospective analysis of 1,014 patients. Anesthesiology 1995;83(4):727–37.
22. [15] Borgeat A, Schäppi B, Biasca N, Gerber C. Patient-controlled analgesia after major shoulder surgery: patient-controlled interscalene analgesia versus patient- controlled analgesia. Anesthesiology 1997;87(6):1343–7.
23. Simpson RS, Macintyre PE, Shaw D, Norton A, McCann JR, Tham EJ. Epidural catheter tip cultures: results of a 4-year audit and implications for clinical practice.
24. Klein SM, Evans H, Nielsen KC, Tucker MS, Warner DS, Steele SM. Peripheral nerve block techniques for ambulatory surgery. Anesth. Analg. 2005;101(6):1663– 76.
25. Chang C, Lin H, Lin H, Lin H. Anesthetic management and surgical site infections in total hip or knee replacement: a population-based study.
26. Anesthesiology 2007;107(6):1034-5; author reply 1035. [54] Mehdipour M, Taghavi Zenoz A, Asvadi Kermani I, Hosseinpour A. A comparison between zinc sulfate and chlorhexidine gluconate mouthwashes in the prevention of chemotherapy-induced oral mucositis. Daru 2011;19(1):71–3.
27. Capdevila X, Jaber S, Pesonen P, Borgeat A, Eledjam J. Acute neck cellulitis and mediastinitis complicating a continuous interscalene block. Anesth. Analg. 2008;107(4):1419–21.
28. [18] Brown DL. Brachial plexus anesthesia: an analysis of options. Yale J Biol Med 1993;66(5):415–31. [19] Bubeck J, Boos K, Krause H, Thies K. Subcutaneous tunneling of caudal catheters reduces the rate of bacterial colonization to that of lumbar epidural catheters. Anesth. Analg. 2004;99(3):689-93, table of contents. [20]
29. Borgeat A, Aguirre J, Curt A. Case scenario: neurologic complication after continuous interscalene block. Anesthesiology 2010;112(3):742–5.
30. Ilfeld BM, Morey TE, Wang RD, Enneking FK. Continuous popliteal sciatic nerve block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study. Anesthesiology 2002;97(4):959–65.
31. [57] Morin AM, Kerwat KM, Büttner J, Litz R, Koch T, Mutters R et al. DGAInfo Hygieneempfehlungen für die Anlage und weiterführende Versorgung von Regionalanästhesie-Verfahren: Die "15 Gebote" des Wissenschaftlichen Arbeitskreises Regionalanästhesie. Anästh Intensivmed 2006:1–9.
32. Tirali R, Bodur H, Ece G. In vitro antimicrobial activity of sodium hypochlorite, chlorhexidine gluconate and octenidine dihydrochloride in elimination of 8.5. Verzeichnis akademischer Lehrer
33. Gasparini JR, Mello SSd, Marques RS, Saraiva RA. Postoperative continuous plexular analgesia. A study on the side effects and risk factors of catheter infection. Rev Bras Anestesiol 2008;58(6):602–13.
34. Kwee W. Standardvorgehen axilläre Plexusblockade (ultraschallgestützt): SOP UKGM Standort Marburg 2010. [49]
35. Steinfeldt W. Standardvorgehen interskalenäre Plexusblockade: SOP UKGM Standort Marburg 2010. [75]
36. Lai KW, Foo TL, Low W, Naidu G. Surgical hand antisepsis-a pilot study comparing povidone iodine hand scrub and alcohol-based chlorhexidine gluconate hand rub. Ann. Acad. Med. Singap. 2012;41(1):12–6.
37. Anesth. Analg. 2006;103(1):229-33, table of contents. [14] Borgeat A, Dullenkopf A, Ekatodramis G, Nagy L. Evaluation of the lateral modified approach for continuous interscalene block after shoulder surgery.
38. Strafford MA, Wilder RT, Berde CB. The risk of infection from epidural analgesia in children: a review of 1620 cases. Anesth. Analg. 1995;80(2):234–8.
39. [58] Morin AM, Kerwat KM, Klotz M, Niestolik R, Ruf VE, Wulf H et al. Risk factors for bacterial catheter colonization in regional anaesthesia. BMC Anesthesiol 2005;5(1):1. [59]
40. [60] O'Horo JC, Silva GLM, Safdar N. Anti-infective locks for treatment of central line-associated bloodstream infection: a systematic review and meta-analysis. Am. J. Nephrol. 2011;34(5):415–22. [61]
41. Hemani ML, Lepor H. Skin preparation for the prevention of surgical site infection: which agent is best? Rev Urol 2009;11(4):190–5.
42. Tamma PD, Aucott SW, Milstone AM. Chlorhexidine use in the neonatal intensive care unit: results from a national survey. Infect Control Hosp Epidemiol 2010;31(8):846–9.
43. Patil HV, Patil VC, Ramteerthkar MN, Kulkarni RD. Central venous catheter- related bloodstream infections in the intensive care unit. Indian J Crit Care Med 2011;15(4):213–23.
44. Monzillo V, Corona S, Lanzarini P, Dalla Valle C, Marone P. Chlorhexidine- silver sulfadiazine-impregnated central venous catheters: in vitro antibacterial activity and impact on bacterial adhesion. New Microbiol. 2012;35(2):175–82.
45. Capdevila X, Bringuier S, Borgeat A. Infectious risk of continuous peripheral nerve blocks. Anesthesiology 2009;110(1):182–8.
46. Geier KO. Bloqueio do nervo isquiático via médio lateral da coxa como opção anestésica no trauma: relato de caso. Rev Bras Anestesiol 2006;56(1):46–51.
47. Lee JH. Catheter-related bloodstream infections in neonatal intensive care units. Korean J Pediatr 2011;54(9):363–7.

Das Dokument ist im Internet frei zugänglich - Hinweise zu den Nutzungsrechten